1. Research Methods in Nursing NUR 602
Celeste Connelly, Kelly Gibson,
Ashley McCann Rogers & Amy Squire

2. Introduction
 5.7 million Americans live with heart failure (HF).
 The cost of care of HF patients was $37.2 billion dollars
in 2009.
 Rapid readmission (readmission to an acute care
facility within 30 days of discharge) for Medicare
patients was 26.9% in 2010.
 Management of heart failure consumes more resources
than any other diagnosis….
 We need to improve care and cut costs.

3. Purpose of the Study/Hypothesis
• To determine if a nurse-delivered discharge planning
bundle that includes a follow-up phone call within 1
week of discharge will decrease the rate of unplanned
admissions among patients with a primary or
secondary diagnosis of HF.
• The addition of a follow-up phone call to a discharge
care bundle will reduce the rapid readmission of
patients with HF to the hospital.

4. Procedures
 January 1 – June 30 – Retrospective chart review to determine
number of rapid readmissions conducted by Quality Improvement
Department of a local hospital. IRB approval obtained from
University of North Carolina at Greensboro. Study was deemed
exempt Category #4. All information was de-identified before
included in the study.
 July 1 – September 30 – Staff education/preparation of unit for
introduction of new discharge care bundle that will include HF
patients - #1 admitting diagnosis on the unit
 October 1 – December 31 – Implement the discharge planning
bundle that includes follow-up phone call.
 January 1 – June 30 - Collect data about rapid readmissions
following implementation the new care bundle.

5. Sampling and Setting
 Target Population: Patients hospitalized for HF.
 Setting: An inpatient 20 bed telemetry unit of a local hospital staffed with
30 RN’s/10 CNA’s /4 Monitor Tech’s

1.
2.
3.
Inclusion Criteria:
Age 65 or older
Discharge diagnosis of HF (as the primary or secondary diagnosis)
Alert and competent to read, understand and speak English

1.
2.
3.
Exclusion Criteria:
Skilled Nursing Facility (SNF) patients
Department of Correction residents
Pregnant women

1.
Protection of Human Rights:
All demographic information was stored on a secure server with
protection by a 2 password system
Patients gave consent to be contacted by telephone following hospital
stay
2.

6. Discharge Care Bundle
 Patients will receive an educational plan that follows the
Self Care of Heart Failure Index (SCHFI) developed in
studies done by Riegel, Lee, Dickson & Carlson (2004).
 Education Concepts/Goals - Self-care maintenance, Self-
care management and Self-care monitoring/confidence.
 The intention of the follow-up phone call is to monitor the
patient understanding of the goals of the program and to
follow their progress as well as answer any questions they
may have. A graduate nurse researcher will attempt to
contact all patients within a week of discharge.

7. Follow-up Phone Call
 Medications:
What medications are you taking and are you taking them as prescribed?
Do you have any questions about your medications?
• Activity:
Are you able to participate in some type of physical activity daily?
 Weight:
Do you weigh yourself daily? Has your weight stayed the same, increased
by > 3# in a day or >5# in a week?
 Diet: Are you following a low sodium diet?
 Symptom Management:
Do your feet/ankles/hands swell? Are you short of breath when you climb
stairs or get dressed in the morning? Are you tired all the time? Can you
participate in your usual activities?
• Follow-up:
Have you seen your primary care provider for your follow-up appointment?
• Can I help you with any other information?

8. Self care of Chronic Illness
A Middle Range Theory
•
•
•
•
Diet
Medications
Exercise
Smoking cessation
Self-care
maintenance
Self-care
monitoring
• Weigh daily
• Monitor B/P HR
• Recognize changes
• Adjust treatment in
response to
changes
• Seek primary care
follow up
Self-care
management

9. Research Approach/Design
 This study will use a Quantitative approach to define if an
enhanced educational program and follow-up phone call
(independent variable) would reduce rapid readmission
(dependent variable) of HF patients after hospitalization.
 This is a Quality Improvement study that will attempt to
show a relationship between the enhanced educational
program and better outcomes for HF patients.
 We will use a pretest/posttest design as we are collecting
information about rapid readmission both before the
discharge planning bundle is initiated and after to
determine the change in rapid readmissions.

10. Outcomes/Statistics
 At the end of our study we will report the number of
readmissions that occurred during the six month period
following the introduction of the discharge planning
bundle.
 Additionally, we may be able to identify any areas of the
educational program that can be improved, indicating
further Quality Improvement opportunities.
 We will employ a graduate student statistician to assist
with the evaluation of the study.

11. Limitations
 We will have a small sample because we have limited
the initiation of the discharge care bundle to one
specific unit in one hospital.
 We have chosen to use a convenience sample which
may limit the ability to apply our findings to a larger
population.
 The discharge planning bundle is being introduced as
a new standard of care but we do not know if the
education is completed or delivered in a consistent
manner with each HF patient.

12. Budget
 Materials /copying fees
 Professional services of statistician
 Total Cost of study
50
500
$ 550

13. Resources
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